Call to Action wants more reporting

Non-punitive culture vital to quality efforts

The list of organizations that participated in the recent National Association for Healthcare Quality's "Call to Action" gives you an idea of how important people from various parts of the healthcare world think the topics addressed in the report are.

Released in October, the NAHQ report "Call to Action: Safeguarding the Integrity of Healthcare Quality and Safety Systems" outlines some of the problems in healthcare, most notably that we do not really know how much harm and potential harm there is, since organizations aren't very good at reporting events and near misses. Without that information, the authors note, how can you know what's wrong? And if you do not know what's wrong, how can you fix it?

The Call to Action outlines four main areas of action: to establish accountability, protect reporters, respond to concerns, and report the data accurately. It notes that many people are afraid to report incidents, and some are even harassed or threatened with adverse consequences should they choose to report something. It is peppered with responses from NAHQ surveys about harassment and intimidation that are shocking and far more common than most organizations would care to admit.

There are several things that organizations can do, the report notes, including continual education from hiring through all employees' careers about the importance of reporting adverse events and near misses, publicizing good catches, benchmarking of data, having clear policies and expectations around the issue of reporting and publicizing them. You need to have just responses to concerns, and have clear policies about the value and importance of people who report problems. Data collection and reporting should be transparent, communication encouraged, and teamwork fostered.

The complete report and its recommendations can be found at

Cynthia Barnard, MBA, MSJS, CPHQ, director of quality strategies at Northwestern Memorial Hospital in Chicago was the main contributor to the report. She says that it is no secret to anyone that there is a large proportion of events that are unreported. "What we are trying to do is show that there are some specific leadership behaviors that encourage unreporting. That means there are behaviors that can encourage reporting, too."

This report needs to be seen by anyone who attends an executive quality meeting, and Barnard says quality managers should read it and present it to senior management and medical staff. "Tell them that this is what a respected consortium of healthcare stakeholders says we should do. Then ask what you can do to bring it to your front door."

There are plenty of organizations that have moved forward on this — Dana Farber and Johns Hopkins both have just cultures that encourage reporting. And both of them changed their culture after tragic events that harmed patients. Virginia Mason in Seattle is another that learned the hard way why culture change is good. "People have terrible things happen that awaken them," Barnard says. Some organizations learn from other's tragedies, too.

None of this is exciting or sexy, she says. "Doing this will not bring you fame." But not doing it might bring infamy, and certainly will not help your patients get the best care. "The public thinks you are already doing this. There are no brownie points for it. You really should be doing all of this already."

Reporting potential safety events is theoretical, she says. Reporting actual events may not even rise to the top of the CEO's to-do list. "But that's not the point. In terms of priorities, that's not how you should think about this. You should think of developing a culture that embraces the reporting of potential problems, where it is okay to speak out."

At Northwestern, where they've been working on this issue for a while, Barnard says she shared the report with quality, risk management, and patient safety staff. "I asked them to hold this up as a mirror and see what we need to do better." Seven years ago, they started monthly conferences where some bad thing that happened, whether it caused harm or not, was talked through, ideas and possible solutions shared. These are open to everyone. Every month, more than 100 people from around the hospital participate. But that's not enough. "It is not everyone. So now we have to think about how to communicate the message more broadly."

She'd like to see organizations do something similar — to hold the recommendations up to their own mirror and see how they stack up. And she'd like to see regulatory agencies emphasize reporting of events and possible events more. "You want a saturation of awareness on how important this all is."

For more information on this topic, contact Cynthia Barnard, MBA, MSJS, CPHQ, Director, Quality Strategies, Northwestern Memorial Hospital, Chicago IL. Telephone: (312) 926-4822. Email: